MEDICARE: JILL ROSATI HENNEBERG FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN.0991886-NP	CO

General Provider Information

NPI Number	:	1457723371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL ROSATI HENNEBERG FNP

Provider Business Mailing Address
First Line	:	2121 NORTH AVENUE
Second Line	:	GRAND JUNCTION VETERANS HEALTH CARE SYSTEMS
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2944
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 NORTH AVENUE
Second Line	:	GRAND JUNCTION VETERANS HEALTH CARE SYSTEMS
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2944
Country	:	US
Telephone Number	:	970-242-0731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	10/30/2015

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